Predictive validity of the Japanese version of
Postpartum Depression Predictors Inventory-Revised
(PDPI-R) during pregnancy and the postpartum period
Mikiyo Wakamatsu, Masayuki Nakamura, Motofumi Kasugai, Hiroshi Kimotsuki, Toshimichi Oki,
Yuji Orita, Shinichi Togami, Hiroaki Kobayashi, Akira Sano, Tsutomu Douchi
Medical Journal of Kagoshima University
September, 2016
Med. J. Kagoshima Univ., September, 2016
Predictive validity of the Japanese version of
Postpartum Depression Predictors Inventory-Revised
(PDPI-R) during pregnancy and the postpartum period
Mikiyo Wakamatsu1,*), Masayuki Nakamura2),
Motofumi Kasugai2), Hiroshi Kimotsuki2), Toshimichi Oki3),
Yuji Orita3), Shinichi Togami3), Hiroaki Kobayashi3),
Akira Sano2), Tsutomu Douchi3)
Affiliation:
1)
Department of Maternal & Child Nursing and Midwifery, Kagoshima University Faculty of Medicine, School of Health Sciences,
8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
2)
Department of Psychiatry, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka,
Kagoshima 890-8544, Japan.
3)
Department of Reproductive Pathophysiology, Obstetrics and Gynecology, Kagoshima University Graduate School of Medical and
Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
(Received 2016 Mar. 4; Revised June. 7; Accepted Jaly. 12)
*Address to Correspondence
Mikiyo Wakamatsu
Department of Maternal & child Nursing and Midwifery Kagoshima University Faculty of Medicine School of Health Sciences,
8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan．
E-mail: [email protected]
Tel: +81-99-275-6792;
Fax: +81-99-275-6792
Abstract
Aim: To identify the risk factors for postpartum depression (PPD) during pregnancy and the early postpartum period is considered
important for preventing the development of PPD. Postpartum Depression Predictors Inventory-Revised (PDPI-R, self-report
questionnaires) was developed from Beck’s updated meta-analysis and correlated with the development of PPD. The purpose of
the present study was to investigate the predictive validity of the Japanese version of PDPI-R during pregnancy and one month after
delivery.
Materials and methods: Pregnant Japanese women (n=192) participated in this study between December 2012 and February 2015
at the Department of Obstetrics and Gynecology, Kagoshima University Hospital and three practitioners in Kagoshima prefecture, all
of which are located in the southern part of Japan. Subjects were 120 pregnant Japanese women who completed PDPI-R during 1023 weeks of gestation and one month postpartum. All subjects delivered full-term healthy babies. PPD symptoms were measured
by the Edinburgh Postnatal Depression Scale (EPDS) one month after delivery. The predictive validity of the Japanese version of
PDPI-R was investigated. After identifying appropriate cut-off values by carrying out a receiver operating characteristic (ROC)
curve, sensitivity, specificity, positive and negative predictive values, and the accuracy of PDPI-R were determined in both versions.
Results: Twelve (10%) out of 120 mothers met the PPD criteria with EPDS scores of 9 or higher. With a prenatal cut-off value of
〔10〕
Med. J. Kagoshima Univ., September, 2016
7.0 after carrying out a ROC curve, the sensitivity and specificity of PDPI-R were 50.0% (6/12) and 87.0% (94/108), respectively.
The positive and negative predictive values of PDPI-R were 30.0% (6/20) and 94.0% (94/100), respectively. The cut-off value of 7.0
was superior to 6.0 and 8.0. With a postpartum appropriate cut-off value of 8.0, sensitivity and specificity were 66.7% (8/12) and
88.0% (95/108), respectively. The positive and negative predictive values were 38.1% (8/21) and 96.0% (95/99), respectively. The
cut-off value of 8.0 was superior to 7.0 and 9.0.
Conclusions: The Japanese version of PDPI-R is a useful instrument for predicting PPD in not only the postpartum period, but also
the prenatal period. An appropriate cut-off value of PDPI-R may be 7.0 in the prenatal version and 8.0 in the postpartum version.
Key words: cut-off value, Edinburgh Postnatal Depression Scale, Japanese version, Postpartum Depression, Postpartum Depression
Predictors Inventory-Revised, risk factor, sensitivity, specificity
Introduction
Materials and methods
Postpartum depression (PPD) is a global phenomenon
Fully informed written consent was obtained from each
that has been reported in 10-15% of mothers in Western
pregnant woman. This study was conducted in accordance
countries.1), 2) Suicides were previously shown to account for
with the Institutional Review Board (No.288) at Kagoshima
3)
up to 20% of deaths during the postpartum period. PPD has
University Hospital and the Helsinki Declaration, 2013.
been implicated in a number of these tragic cases. It has also
The Japanese version of PDPI-R was used after obtaining
been shown to affect a partner’s mental health and child’s
permission from Beck CT. PDPI-R was translated from
socio-psychiatric development,2, 4) and has been associated
English into Japanese by psychiatrists and a midwife, then
with child neglect and abuse.
5, 6)
Although every pregnant
woman is at risk of developing PPD, those with specific risk
2, 7)
translated back into English by a bilingual doctor. The
Japanese version of PDPI-R was completed in consensus.
Thus,
Pregnant Japanese women (n=203) participated in this study
identifying the risk factors for PPD during pregnancy and the
between December 2012 and February 2015 at the Department
early postpartum period is considered important for preventing
of Obstetrics and Gynecology, Kagoshima University Hospital
the development of PPD. Postpartum Depression Predictors
and three practitioners in Kagoshima prefecture, all of which
Inventory-Revised (PDPI-R, self-report questionnaires) was
are located in the southern part of Japan. Exclusion criteria
developed from Beck’s updated meta-analysis8) and correlated
included women who refused entry to this study (n=11),
factors may be at a higher risk of developing PPD.
9-11)
Compared with PDPI-R,
those who had a past history of medically-treated psychiatric
the other instrument developed by Webster et al. does not
disorders including (postpartum) depression (n=4), those who
assess factors including socio-economic status, marital status,
could not understand Japanese, (n=1) and those who dropped
child care stress, life stress, and prenatal depression, and is
out (n=67). Drop out cases included premature delivery (n=3),
12)
intrauterine fetal death (n=1), and incomplete PDPI-R (n=63).
In previous screening instruments summarized by Ikeda et
Incomplete PDPI-R cases were almost all in postpartum
with the development of PPD.
only used in the postpartum period, not during pregnancy.
13)
several items adopted in PDPI-R
women due to being busy with childcare. Thus, 120 women
were absent. PDPI-R has the advantage of being the only
were enrolled in this study. All subjects completed PDPI-R
al.
and Beck et al.
8, 14)
prenatal screening scale.
8, 14)
In Japan, there have been no
prenatal instruments to predict PPD.
Therefore, the purpose of the present study was to
(self-report questionnaires) during 10-23 weeks of gestation
and one month postpartum. Gestational age at the first survey
was 17.3 weeks (SD ＝ 4.2)．
investigate the clinical usefulness of the Japanese version
All subjects delivered full-term healthy babies. Baseline
of PDPI-R and determine its predictive validity during the
characteristics included age, gestational age, marital status,
prenatal and postpartum periods.
employment status, socio-economic status, and parity.
PDPI-R during 10-23 weeks of gestation included 10 items:
1) marital status, 2) socio-economic status, 3) self-esteem, 4)
prenatal depression, 5) prenatal anxiety,
〔11〕
Japanese version of PDPI-R
6) unplanned/unwanted pregnancy, 7) history of previous
as 1, while its absence was registered as 0. After identifying
depression, 8) social support, 9) marital dissatisfaction, and
appropriate cut-off values by carrying out a receiver operating
10) life stress.
characteristic (ROC) curve, sensitivity, specificity, positive
Total scores on the prenatal version of PDPI-R ranged
and negative predictive values, and the accuracy of PDPI-R
from 0 to 32. Three additional items were included in the
were determined in both versions. P<0.05 was considered
postpartum PDPI-R examination one month after delivery: 11)
significant. Statistical analyses were performed using SPSS,
child care stress, 12) infant temperament, and 13) maternity
version 22 (IBM, Armonk, NY, USA).
blues. Total scores on the postpartum version ranged from
Results
0 to 39. PPD symptoms were measured by the Edinburgh
Postnatal Depression Scale (EPDS)
15)
one month after
delivery. Women with EPDS scores of 9 or higher were
suspected of PPD in the Japanese criteria.16-18)
Twelve (10.0%) out of 120 mothers met the PPD criteria
with EPDS scores of 9 or higher. Table 1 shows the baseline
characteristics of the enrolled subjects (n=120). The
Statistical analysis
percentages of primiparous and married women were 51.7%,
and 89.2%, respectively. Only 2.5% of the women were
Intra- and inter-group comparisons were performed by the
single. A quarter of the women (24.2%) had a low socio-
McNemar test, Wilcoxon rank-sum test, and Mann-Whitney
economic status. No significant differences were observed in
U test, as appropriate. Relationships between variables were
the distribution of marital status, employment status, socio-
assessed by the Spearman rank correlation test. A univariate
economic status and parity between the two groups. Mean
logistic regression analysis was used to determine the odds
age was 30.1 years (SD=4.6)．
ratio of 13 items in the development of PPD. The strength of
Table 2 shows changes in risk factor scorings of PDPI-R
the odds ratio was explained as a 95% confidence interval (CI).
during pregnancy and the postpartum period in all subjects.
In this analysis, the independent variable was the presence
The low self-esteem variable was significantly different
or absence of PPD (non-PPD), while the dependent variables
between the pregnancy and the postpartum periods (p<0.05).
were the 13 items tested. The presence or absence of PPD was
No significant differences were observed in the other 9
a nominal variable, and the presence of PPD was registered
variables between the two time points. Table 3 shows the
Table 1 Baseline characteristics of enrolled subjects (n=120)
n (%)
PPD
non-PPD
p
(Fisher’s exact test)
Single
Married
Separated
Partnered
3 (2.5)
107 (89.2)
1 (0.8)
9 (7.5)
 1
10
 0
 1
 2
97
 1
 8
0.474
Housewife
Employed
Part-time
Self-employed
48 (40.0)
53 (44.1)
17 (14.2)
2 (1.7)
 3
 7
 2
 0
45
46
15
 2
0.593
Socio-economic status
Low
Medium
High
29 (24.2)
90 (75.0)
1 (0.8)
 4
 8
 0
25
82
 1
0.304
Parity
0
1
2
3
62 (51.7)
45 (37.5)
11 (9.2)
2 (1.7)
 7
 3
 1
 1
55
42
10
1
0.450
Marital status
Employment status
〔12〕
Med. J. Kagoshima Univ., September, 2016
Table 2 Changes in risk factor scorings of PDPI-R during pregnancy and the postpartum period (n=120)
Median (range) † / Number (%)
Range
Prenatal variables
F1 Being single
F2 Low socio-economic status
F3 Low self-esteem ǂ
0-1
0-1
0-3
F4 Perinatal depression
F5 Prenatal anxiety
F6 Pregnancy intendedness §
0-1
0-1
0-2
F7 Prior depression
F8 Lack of social support //
F9 Marital dissatisfaction ¶
F10 Life stress **
Postpartum variables
F11 Child care stress ††
0-1
 0-12
0-3
0-7
0-3
F12 Infant temperament §§
0-3
F13 Maternity blues
0-1
*
ǂ
§
//
¶
**
††
§§
During pregnancy
1
2
3
1
2
1
2
3
1
2
1
2
3
  3 (2.5)
29 (24.2)
23 (19.2)
24 (20.0)
  7 (5.8)
12 (10.0)
74 (61.7)
41 (34.2)
  2 (1.7)
10 (8.3)
  0 (0-8) †
18 (15.0)
  2 (1.7)
  2 (1.7)
  0 (0-3) †
One month postpartum
p
(McNemar
Wilcoxon)
  1 (0.8)
25 (20.8)
27 (22.5)
15 (12.5)
  5 (4.2)
19 (15.8)
71 (59.2)
41 (34.2)
  2 (1.7)
11 (9.2)
  0 (0-7) †
18 (15.0)
  5 (4.2)
0.625
0.523
 0.018*
  0 (0-4) †
0.800
0.167
0.749
0.987
0.705
0.228
0.859
28 (23.3)
  8 (6.7)
52 (43.3)
22 (18.3)
  3 (2.5)
51 (42.5)
p < 0.05
Do you feel good about yourself?
Do you feel worthwhile?
Do you have good qualities?
Was the pregnancy planned?
Was the pregnancy unwanted?
Do you believe that you receive adequate emotional support from your (partner/family/friends)?
Do you believe that you can confide in your (partner/family/friends)?
Do you believe that you can rely on your (partner/family/friends)?
Do you believe that you receive adequate instrumental support from your (partner/family/friends)?
Are you satisfied with your marriage or living arrangement?
Are you currently experiencing any marital relationship problems?
Are things going well between you and your partner?
Are you currently experiencing any stressful events in your life such as (financial problems/marital problems/death in family/unemployment/
serious illness in family/moving/job change)?
Is the infant experiencing any health problems?
Are you having problems feeding the baby?
Are you having problems with the baby sleeping?
Would you consider the baby irritable?
Does the baby cry a lot?
Is your baby difficult to console or soothe?
〔13〕
Japanese version of PDPI-R
Table 3 Distribution of Postpartum Depression cases at two time points during pregnancy
Gestational age 10-16 weeks
n (%)
Gestational age 17-23 weeks
n (%)
P
(Chi-square test)
4 (7.7)
48 (92.3)
8 (11.8)
60 (88.2)
0.461
PPD
non-PPD
Table 4 Total PDPI-R scores in PPD and non-PPD women at two time points
Prenatal version
Postpartum version
med.
PPD (n=12)
min.
max.
med.
6.50
8.00
2
3
16
17
3.00
4.00
non-PPD (n=108)
min.
max.
0
0
p
(Mann-Whitney U test)
13
17
< 0.05
< 0.001
Table 5 Odds ratio of PDPI-R variables in the development of PPD
During pregnancy
Odds Ratio
95% Cl
Prenatal version
F1 Being single
F2 Low socio-economic status
F3 Low self-esteem
F4 Prenatal depression
F5 Prenatal anxiety
F6 Pregnancy intendedness
F7 Prior depression
F8 Lack of social support
F9 Marital dissatisfaction
F10 Life stress
Postpartum version
F11 Child care stress
F12 Infant temperament
F13 Maternity blues
4.82
1.58
1.67
1.96
3.18
0.84
1.14
1.29
2.26
1.50
One month postpartum
Odds Ratio
95% Cl
0.40 - 57.50
0.44 - 5.66
0.95 - 2.95
0.38 - 10.22
0.66 - 15.24
0.25 - 2.76
0.13 - 9.95
0.99 - 1.69
1.04 - 4.90*
0.70 - 3.19
NA
2.07
2.92
5.22
3.85
1.62
1.00
1.43
2.30
1.58
NA
0.57 - 7.54
1.56 - 5.45†
1.44 - 18.88*
0.81 - 18.43
0.55 - 4.76
0.12 - 8.65
1.08 - 1.89*
0.93 - 5.67
0.88 - 2.83
2.10
1.87
4.71
0.91 - 4.84
0.91 - 3.86
1.21 - 18.42*
* p < 0.05
† p < 0.01
CI = confidence interval
NA = not available
Table 6 Spearman rank correlation test between variables in the prenatal version (n=120)
Total score
Total score
F3 Self-esteem
F4 Prenatal depression
F5 Prenatal anxiety
F6 Unplanned/unwanted pregnancy
F7 History of previous depression
F8 Social support
F9 Marital dissatisfaction
F10 Life stress
* p < 0.05
† p < 0.01
ns = not significant
1
0.567†
0.128
0.279†
0.294†
-0.047
0.717†
0.432†
0.391†
F1
F2
F3
F4
ns
ns
1
―
ns
1
－
ns
－
－
－
0.208* ns
ns
ns
ns
－
－
－
ns
ns 0.228* ns
0.190* ns 0.201* 0.188*
ns 0.191*
ns
ns
F5
F6
F7
1
ns
－
ns
ns
ns
1
ns
ns
ns
ns
1
ns
ns
ns
F8
F9
1
0.307†
1
0.250† 0.271†
F10
1
〔14〕
Med. J. Kagoshima Univ., September, 2016
distribution of the postpartum depression casas at two time
of 8.0. The postpartum cut-off value of 8.0 was superior to
points during pregnacy. The distribution of PPD was not
7.0 and 9.0. The positive and negative predictive values were
significantly different between the two time points. Table
38.1% (8/21) and 96.0% (95/99), respectively. The positive
4 shows total PDPI-R scores in PPD (n=12) and non-PPD
predictive cut-off value of 8.0 was superior to 7.0 and 9.0. In
women (n=108) at the two time points. In the prenatal
addition the postpartum version was superior to the prenatal
PDPI-R version, median scores were higher in PPD than in
version (38.1% and 30.0%, respectively.).
non-PPD women. In the postpartum version, median scores
Discussion
were also higher in non-PPD women. Median scores were
higher in the postpartum version than in the prenatal version in
both groups. The spearman rank correlation test between total
The prevalence of PPD is suggested to vary with the
PDPI-R scores at two time points. The prenatal version was
mother’s background including age, parity, educational level,
positively correlated with the postpartum version (r=0.394,
socio-economic status, marital status, social support, culture,
p<0.001).
geography, and race.7) It may also differ based on the number
Table 5 shows the odds ratio of PDPI-R items in the
of women with a past history of depression and the cut-off
development of PPD from a univariate logistic regression
value of EPDS.13, 19-23) The cut-off value of EPDS is generally
analysis. In the prenatal version, marital dissatisfaction was
higher in Western countries19, 21-23) than in Japan.16-18) However,
identified as a significant predictor of PPD (Odds ratio; 2.26,
accumulating evidence has indicated that the prevalence of
95% CI; 1.04-4.90, p<0.05). In the postpartum version, low
PPD is similar.14, 16, 17, 24-26) In the present study, the prevalence
self-esteem (odds ratio; 2.92, 95% CI; 1.56-5.45, p<0.01),
of PPD determined based on EPDS scores of 9 or higher was
prenatal depression (5.22, 1.44-18.88, p<0.05), lack of
10.0%. This prevalence rate was not different from previous
social support (1.43, 1.08-1.89, p<0.05), and maternity blues
findings.14, 17, 24, 25, 27, 28)
(4.71; 1.21-18.42, p<0.05) showed significant high odds
In the prenatal PDPI-R version, a history of depression,
ratios. Tables 6 and 7 show the results of the Spearman
current depression/anxiety, and low level of partner support
rank correlation test between variables in the prenatal and
have been associated with the occurrence of PPD.7) Current
postpartum versions. In the prenatal version, low self-
depression/anxiety may be amenable to change and, thus may
esteem positively correlated with the lack of social support
be targeted for medical intervention.7) In the present study,
(r=0.228, p<0.05), marital dissatisfaction (0.201, p<0.05),
among the 10 variables tested, only marital dissatisfaction
and total scores (0.567, p<0.01) (Table 6). In the postpartum
was identified as a significant predictor of PPD. This result
version, prenatal depression was positively correlated with
was inconsistent with the findings of Milgrom et al.7) Possible
marital dissatisfaction (0.251, p<0.01), and total PDPI-R
explanations for this discrepancy include differences in the
scores (0.309, p<0.01) (Table 7). Maternity blues positively
number of enrolled subjects, subject backgrounds, screening
correlated with infant temperament (0.204, p<0.05) and total
instruments, and culture. In the present study, marital
scores (0.289, p<0.01).
dissatisfaction was associated with prenatal depression and
After carrying out a ROC curve, appropriate cut-off values
the lack of social support in a univariate regression analysis.
were identified as 7.0 in the prenatal version and 8.0 in the
Therefore, our results did not always disagree with those by
postpartum version. Table 8 shows the sensitivity, specificity,
Milgrom et al.
positive and negative predictive values, and accuracy in
The postpartum period is characterized by increased
appropriate and nearly appropriate cut-off values in the two
susceptibility to different mood disorders of varying
versions. With a prenatal cut-off value of 7.0, sensitivity
severity.29) This is also supported by the results of the present
and specificity were 50.0% (6/12) and 87.0% (94/108),
study, which showed that the total PDPI-R score increased
respectively. The prenatal cut-off value of 7.0 was superior
in the postpartum period in not only PPD, but also non-PPD
to 6.0 and 8.0. The positive and negative predictive values
women. Maternity blues has been reported in approximately
of PDPI-R during pregnancy were 30.0% (6/20) and 94.0%
40-70% of postpartum women within a few days of delivery
(94/100) at a cut-off value of 7.0, respectively. The positive
in Western countries.30, 31) Although the etiology of maternity
predictive cut-off value of 7.0 was superior to 6.0 and 8.0. In
blues remains unclear, maternity blues and PPD are common
the postpartum version, sensitivity and specificity were 66.7%
complications in postpartum women. Previous studies
(8/12) and 88.8% (95/108), respectively, with a cut-off value
have investigated the relationship between the severity of
〔15〕
Japanese version of PDPI-R
Table 7 Spearman rank correlation test between variables in the postpartum version (n=120)
Total score F1
Total score
F3 Self-esteem
F4 Prenatal depression
F5 Prenatal anxiety
F6 Unplanned/unwanted pregnancy
F7 History of previous depression
F8 Social support
F9 Marital dissatisfaction
F10 Life stress
F11 Child care stress
F12 Infant temperament
F13 Maternity blues
1
0.409†
0.309†
0.193*
0.389†
0.145
0.513†
0.270†
0.466†
0.405†
0.458†
0.289†
F2
F3
F4
F5
F6
F7
F8
F9 F10
ns
ns
1
ns
1
－
－
1
－
－ 0.265† －
ns 0.277† ns
ns
ns
ns
－
－
－
－
ns
ns 0.265† ns
ns
ns
ns
ns 0.251† ns
ns 0.330† 0.188* ns
ns
ns
ns
ns
ns
ns
ns
ns
ns
ns
ns
―
ns
－
－
－
1
ns
ns
ns
ns
ns
ns
ns
1
ns
1
ns 0.251† 1
ns 0.200* ns
ns
ns
ns
ns
ns
ns
ns
ns
－
F11
F12 F13
1
ns
1
ns 0.257†
1
ns
ns 0.204* 1
* p < 0.05
† p < 0.01
ns = not significant
Table 8 Sensitivity, specificity, positive and negative predictive values, accuracy of appropriate and nearly appropriate
cut-off values in the two versions
Cut-off value
Sensitivity
Specificity
Positive predictive value Negative predictive value
Accuracy
Prenatal version of PDPI-R
 5.0
66.6% (8/12)
 6.0
58.3% (7/12)
  7.0
50.0% (6/12)
 8.0
33.3% (4/12)
 9.0
33.3% (4/12)
10.0
  8.3% (1/12)
11.0
  8.3% (1/12)
72.2% (78/108)
81.5% (88/108)
87.0% (94/108)
89.8% (97/108)
92.6% (100/108)
95.4% (103/108)
97.2% (105/108)
21.1% (8/38)
25.9% (7/27)
30.0% (6/20)
26.7% (4/15)
33.3% (4/12)
16.7% (1/6)
25.0% (1/4)
96.3% (78/81)
94.6% (88/93)
94.0% (94/100)
92.4% (97/105)
92.6% (100/108)
90.4% (103/114)
90.5% (105/116)
70.8%
79.1%
83.3%
84.1%
86.7%
86.7%
88.3%
Postpartum version of PDPI-R
 6.0
83.3% (10/12)
 7.0
75.0% (9/12)
  8.0
66.7% (8/12)
 9.0
41.7% (5/12)
10.0
33.3% (4/12)
11.0
33.3% (4/12)
12.0
33.3% (4/12)
70.4% (76/108)
80.6% (87/108)
88.0% (95/108)
88.9% (96/108)
91.7% (99/108)
93.5% (101/108)
95.4% (103/108)
23.8% (10/42)
30.0% (9/30)
38.1% (8/21)
29.4% (5/17)
30.8% (4/13)
36.4% (4/11)
44.4% (4/9)
97.4% (76/78)
96.7% (87/90)
96.0% (95/99)
93.2% (96/103)
92.5% (99/107)
92.7% (101/109)
92.8% (103/111)
71.6%
80.0%
85.8%
84.2%
85.8%
87.5%
89.2%
maternity blues and the risk of PPD. 10, 11, 17, 20, 27, 30-34) In the
support, were associated with the development of PPD in
postpartum version, we found that maternity blues was a
Korean mothers.20) Beck found that maternity blues was one
significant predictor of PPD (odds ratio=4.71) as well as
of the important predictors of PPD.10) Thus, we must pay
prenatal depression (5.22), low self-esteem (2.92), and the
particular attention to mothers with maternity blues in order
lack of social support (1.43). Our results were consistent
to prevent the development of PPD.14, 17) Similar to maternity
with previous findings.8, 10, 11, 17, 20, 24, 27, 31-34) Watanabe et al.
blues, prenatal depression, low self-esteem, and the lack of
reported that maternity blues was a strong predictor of PPD,
social support were identified as significant predictors of PPD.
and the higher the blues score, the higher the risk of PPD (odds
These results agree with previous findings.13, 19) Thus, we
ratio=9.57).
27)
Youn et al. also demonstrated that maternity
blues, as well as prenatal depression and the lack of social
must also pay close attention to women lacking social support
and/or with a past history of prior or prenatal depression.
〔16〕
Med. J. Kagoshima Univ., September, 2016
With an appropriate prenatal cut-off value of 7.0, sensitivity
6 months of pregnancy, while Ikeda et al. conducted theirs
and specificity were 50.0% and 87.0%, respectively. These
at 8 months of pregnancy.13) These differences may have
results are consistent with previous findings reported by Ikeda
led to slight differences in prenatal cut-off values. Beck et
et al.13), but were inferior to those by Oppo et al.19) However,
al. previously reported a postpartum cut-off value of 10.5.14)
in the study by Oppo et al. PDPI-R was performed at 8
However, PDPI-R was examined at two and six months
months of gestation.19) The different timing of PDPI-R may
postpartum. PPD occurs four weeks after delivery, and its
have led to different cut-off values. With the postpartum cut-
risk increases within the first 3 months of delivery.36) Thus,
off value of 8.0, sensitivity and specificity were 66.7% and
the cut-off value of PDPI-R may become high at two months
88.0%, respectively. Sensitivity was inferior, while specificity
postpartum. Additionally, there were 10 to 13 variables in
was superior to those reported by Ikeda et al.13) and Oppo et
PDPI-R; however, the distribution of each variable may differ
19)
The reasons for these discrepancies currently remain
with the population examined. In the present study, marital
unclear. In the present study, the sensitivity and positive
dissatisfaction (odds ratio = 2.26) in the prenatal version, and
predictive value of PDPI-R were higher in the postpartum
maternity blues (4.71) and prenatal depression (5.22) in the
version than in the prenatal version, and this was attributed
postpartum version were significant predictors of PPD. Odds
to the timing of postpartum PDPI-R being near to the onset
ratios of maternity blues and prenatal depression were high,
of PPD. The results of the present study demonstrated that
despite the lower scale and scoring. When some variables
PDPI-R was characterized by higher specificity and a higher
with a low scale and scoring, but a high odds ratio, such as
negative predictive value. However, a careful follow-up and
marital dissatisfaction, maternity blues, prenatal depression,
appropriate counselling are necessary for reducing the risk of
and prior depression, are one-sided and strong (i.e., high
PPD in women with more than an appropriate cut-off value.
odds ratio) predictors of PPD, the cut-off value may become
In addition, there was a positive correlation in the total score
low. Oppo et al. previously reported low cut-off values (4.0
of both prenatal and postpartum versions. Thus, the Japanese
in the prenatal and 6.0 in the postpartum version), with high
version of PDPI-R is a useful instrument for predicting PPD
odds ratios for maternity blues (odds ratio=4.9) and prenatal
in not only the postpartum, but also prenatal period. This is
depression (9.97),19) and these two variables were given a low
important for supporting women at high risk for PPD during
scale (0 or 1). In the study by Ikeda et al., the percentages
pregnancy.
of prenatal depression and prior depression in the prenatal
al.
We identified appropriate cut-off values of 7.0 in the
version were two-fold higer than our values.13) Thus, the
prenatal and 8.0 in the postnatal version of PDPI-R. The
cut-off value of PDPI-R may differ with the distribution
higher postpartum cut-off value was attributed to it having
of variables. Furthermore, a previous study reported that
more variables. However, disagreements persist with regard
the incidence of suicide attempt due to depression differed
13, 14, 19, 35)
Possible explanations
between the climates in the northern and southern parts of
for this discrepancy may include the following. Ikeda et al.
Japan.37) Regional variations may exist in the prevalence of
reported that an appropriate prenatal cut-off value was 6.0 and
PPD even in the same country.38) Thus, cut-off values may
13)
be slightly different among the urban and rural, as well as
Their postpartum cut-off value was the same ours. Possible
southern and northern parts of a country, as shown by the
reasons for the slight difference in the prenatal cut-off value
present study and by Ikeda et al.13) The accuracy of EPDS
may include differences in the number of enrolled subjects,
may also be involved in the difference observed in PDPI-R
percentage of single mothers, low socio-economic status, and
cut-off values. An extreme dominance in false positive cases
those with a past history of depression among the enrolled
of EPDS in the studied population may be associated with
subjects. In the present study, subjects with medically-treated
lower PDPI-R cut-off values, while extreme dominance in
psychiatric disorders were excluded, but were included in
false negative cases of EPDS may be associated with higher
the study by Ikeda et al.13) In the study by Ikeda et al., all
PDPI-R cut-off values. In addition, differences in the manner
subjects were urban women without a low socio-economic
by which the EPDS examination was conducted, interviews or
status and with a high education level, which was significantly
self-report questionnaires, may produce different PDPI-R cut-
different from our study on primi-, multiparous women, in
off values. Moreover, differences in the EPDS cut-off values
which a quarter of women had a low socio-economic status.
may influence PDPI-R cut-off values. Low cut-off values for
Furthermore, we performed a prenatal examination within
EPDS may be associated with low cut-off values for PDPI-R.
to the cut-off value of PDPI-R.
postpartum cut-off value was 8.0 in the Japanese version.
〔17〕
Japanese version of PDPI-R
Acknowledgments
However, this possibility may be denied by the relatively low
EPDS cut-off value (9.0) with a high cut-off value for PDPI-R
in our study and Ikeda’s study,13) and the relatively high EPDS
This study was supported by JSPS KAKENHI Grant
cut-off value (13.0) with a low cut-off value for PDPI-R in the
Number 25463480. We appreciate the cooperation of Tom
study by Oppo et al.19)
Ijyuin, MD, Mitsuhiro Nakae, MD, Shinichi Yamamoto, MD
Other than a prenatal examination of PDPI-R, the ideal
timing of the postpartum PDPI-R examination currently
in generously collecting data for our study. We also thank to
all women who participated in this study.
remains unclear. Maternity blues is a strong predictor of the
development of PPD,10, 17, 20, 27, 30-34) occurs within the first few
days of delivery, and continues for one week. Therefore, one
to two weeks after delivery may be the ideal timing for the
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Postpartum Depression Predictors Inventory-Revised (PDPI-R) 日本語版による
産後うつ病発生の予測に関する検討
若松美貴代１＊）、中村雅之２）、春日井基文２）、肝付洋２）、沖利通３）、折田有史３）、戸上真一３）、
小林裕明３）、佐野輝２）、堂地勉３）
１）
鹿児島大学医学部保健学科　看護学専攻 母性・小児看護学講座
２）
鹿児島大学大学院　医歯学総合研究科　社会・行動医学講座 精神機能病学分野
３）
鹿児島大学大学院　医歯学総合研究科　発生発達成育学講座 生殖病態生理学分野
目的：産後うつ病（Postpartum Depression：PPD）は本人の自殺，パートナーや子供のメンタルヘルス，認知機能，社
会的・情緒的発達，虐待とも関連する。PPD 関連の自殺者は産科出血による死亡数より多いとする報告もある。故に
妊娠中，産褥早期にリスク因子を見つけてケアすることが重要である。今回米国で開発された Postpartum Depression
Predictors Inventory-Revised ( PDPI-R ) を産褥期だけでなく妊娠中にも検査し，PPD を妊娠期に予測出来るか否かを検
討した。
方法：2012 年 12 月から 2015 年 2 月までに，鹿児島県内産婦人科に通院中，または入院中の妊婦で精神科疾患の既
往がなく研究同意が得られた者を対象とした。PDPI-R は日本語に翻訳した後に逆翻訳し，原尺度と比較検討し日本語，
英語について整合性の得られたもので日本語翻訳を完成させた。妊娠 10-23 週に PDPI-R ( 自己評価票 ) 産前版（social
support の欠如，life stress などのリスク因子 10 項目，0-32 点満点）と産褥１ヶ月に PDPI-R 産後版（産前版 10 項目
+ 育児ストレス，子どもの気質，maternity blues のリスク因子 3 項目，合計 13 項目，0-39 点満点）を実施し産前と
産後の 2 時点で完全に解答し終えた 120 人を対象とした。PPD のスクリーニングはエジンバラ産後うつ病自己評価票
9 点以上とした。Receiver operating characteristic curve を用いて，PDPI-R の妥当な cut-off 値を決め，PPD のハイリス
ク群が予測出来るか否かを検討した。
結果：１）PPD は 12 人（10％）であった。２）妊娠中 PDPI-R の cut-off 値を 7.0 に決定したとき，PPD 予測の感度は
50.0％（6/12），特異度は 87.0％（94/108）であり，cut-off 値 6.0，8.0 のそれらに比較して優れていた。陽性，陰性
的中率も 7.0 が優れていた。３）産褥期 PDPI-R の cut-off 値を 8.0 にしたとき，感度は 66.7％（8/12），特異度 88.0％
（95/108）であり，cut-off 値 7.0 と 9.0 のそれらに比較して優れていた。陽性，陰性的中率も 8.0 が優れていた。
結論：PDPI-R 日本語版は産褥期だけでなく妊娠中から産後うつ病のハイリスク群を予測できる有用な方法である。本
研究での PDPI-R の cut-off 値は妊娠中で 7.0，産褥 1 ヶ月で 8.0 が妥当であると思われた。我々の設定した cut-off 値は
本邦の他の報告と類似するが，欧米の報告より cut-off 値が高かった。

第2回オープンキャンパス 模擬授業開講科目一覧 - Akita International

双極Ⅰ型障害における大うつ病エピソードからの